A Hybrid Model combining On-site & Remote Video Consultation for Rural Rheumatology
By Dr Irwin Lim, Rheumatologist
I previously blogged about trying to provide video consultation services (telehealth), to try and bridge the tyranny of distance for rheumatology patients in rural and regional Australia. The overwhelming majority of Australian rheumatologists work in a metropolitan setting. We realise the need to deliver services to the “bush” but we already have a stretched workforce.
Herman Lau & I have been performing video consultation services with Dr Ash Collins, a GP in Temora (418km away) and his patients. This seems a useful service but for us rheumatologists, there is a major downside.
The lack of touch. The lack of being able to physically examine the patient does play on our minds.
To try and solve this, we decided to provide a fly-in service to Temora. Once every 3 months, Herman & I would run a rheumatology clinic at Temora Medical Centre over 2 days.
We plan to see new patients in the flesh with follow up consultations performed remotely via video consultation. If our patients require face-to-face consultation, especially when we need to examine them ourselves, we can see the patient at our next visit.
We’re in Temora now, at our 1st clinic. It’s about half full and that was good, as we wanted time to adjust and make sure that our processes worked.
I thought it would be good to share with you a summary of our 2 days:
- Door-to-door, including the 1 hour flight to the regional centre, Wagga Wagga, followed by hiring a car, took 4.5 hours
- While I was buying lunch at the local sandwich shop, I was complimented. When I told the shopkeeper that I was at the medical centre, he enquired if I was training to be a doctor.
- Computer issues for Herman. While we could easily access our medical software/database in Sydney to consult remotely in Temora, he couldn’t get the printer & his speech dictation system to work.
- We saw some lovely, friendly patients. Some who were very impaired by their rheumatic disease. We instituted some treatment, arranged some investigations and will follow-up most in a few weeks via video consultation.
- There were 2 medical students on their rural rotations who sat in with us. This was an unexpected bonus & it was lovely to be able to teach rheumatology to a new generation (rheumatology teaching is unfortunately very under-resourced at undergraduate level).
- At the end of the long day, we had dinners at Diner’s Choice, a nice restaurant attached to the local bowling club. Portions are huge by Sydney standards.
- It was then off to Koreela Park Motor Inn, to catch up on daily paperwork, before a restful night.
- The next morning, I was interviewed by Prime 7, a regional TV station.
- We then saw more patients, I drained a swollen knee, and I used my portable ultrasound machine to scan a number of joints.
- After a quick lunch, we visited the local attraction, Temora Aviation Museum, for about half an hour before heading home to Sydney. Another 4.5 hour journey.
It’s important to realise that an important issue affecting the long term viability of this sort of service, is the financial loss and time cost of being away from home/family.
We were only about half-full with patients this 1st visit, and the total billings did cover the significant costs involved with traveling, the facility hire fees and our ongoing costs for our Sydney practice while we were away. However, both Herman & I had to be prepared to give up the usual income we would generate seeing patients in Sydney.
This is an important consideration for any rheumatologist considering providing an on-site service to rural & regional Australia. The more often you travel, the more it will cost. A lot of goodwill is required in the absence of any other funding or support to try and help establish these sorts of services. Such funding is in short supply.
All-in-all, I think we accomplished quite a bit. We’ve set in train a possible model to try and help the situation for patients living in rural settings.
Please share any thoughts or relevant experiences you may have.
For those of you overseas, are there similar models you are aware of?
Arthritis requires an integrated approach. We call this, Connected Care.